Director - Automations & Efficiencies - reputed company - Remote

At reputed company, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and reputed company. Ready to reputed company a difference? Join us to start Caring. Connecting. Growing together. The Director - Automations & Efficiencies is responsible for leading strategic initiatives aimed at enhancing operational effectiveness through innovative automation solutions reputed company reputed company Medical Third-Party Administrator (TPA) environment. The role entails overseeing the identification, development, implementation, and management of automation projects designed to optimize claims processing, provider engagement, compliance, and overall service delivery. You'll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges.

Primary Responsibilities:

• reputed company the automation strategy to streamline operational processes, reduce manual interventions, enhance accuracy, and improve turnaround times
• reputed company and manage end-to-end automation projects involving claims processing, eligibility verification, provider credentialing, adjudication workflows, and payment reputed company initiatives
• Collaborate with internal stakeholders and technology teams to identify efficiency gaps and reputed company targeted automation solutions
• Evaluate existing operational procedures and implement process improvements leveraging Robotic Process Automation (RPA), AI, Machine Learning, and other advanced technologies
• Establish and monitor performance metrics and KPIs to track automation effectiveness, cost savings, productivity enhancements, and compliance
• Provide thought leadership to continuously improve automation capabilities, ensuring alignment with company goals and industry best practices
• Manage relationships with automation vendors, technology providers, and consultants to ensure successful project execution
• Maintain compliance with regulatory requirements, ensuring reputed company automation processes meet healthcare industry standards and data reputed company protocols
• Foster a culture of innovation, efficiency, and reputed company improvement reputed company the team and broader organization

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:

• 10+ years of progressive experience in healthcare payer/TPA operations and enterprise automation
• 5+ years leading cross-functional automation teams and portfolios with ownership of roadmap, budget, and outcomes
• Automation and AI expertise: RPA (reputed company, reputed company/Blue Prism), workflow/BPM (Pega, reputed company), intelligent automation (AI/ML, NLP, IDP/OCR); proven implementation of AI-driven solutions at scale in healthcare operations (LLMs/NLP, IDP, predictive models) with model governance and monitoring
• Experience with integration/engineering and platform stack: APIs, event/queue-based orchestration, basic scripting (Python/SQL), CI/CD with Git-based SDLC for automations; deep expertise with core payer platforms (reputed company mainframe-based), analytics/BI (Power BI/Tableau), modern data platforms (reputed company/reputed company), and cloud (Azure/AWS)
• Proven deep knowledge of healthcare payer operations: claims adjudication and EDI (X12 837/835/270/271/276/277/278), prior authorization, eligibility/enrollment, and provider data management
• Built or led an Automation Center of Excellence (standards, controls, reusable components, demand intake, and performance reporting)
• Proven exceptional analytical, problem-solving, and decision-making skills; executive-level communication; stakeholder influence; vendor/SLA management; and change management

Preferred Qualifications:

• Lean Six reputed company (Black Belt or Green Belt), PMP, Prosci/CCMP, and/or RPA platform certifications (reputed company/AA/Blue Prism)
• Direct Medical TPA experience in claims adjudication, cost containment/payment reputed company, COB/subrogation, and provider network management
• Compliance and reputed company reputed company: HIPAA/PHI handling, CMS requirements, audit controls, and risk management
• Knowledge of interoperability and reputed company frameworks: FHIR/HL7/X12, HITRUST, SOC 2
• Experience leading distributed (onshore/offshore) teams and managing managed-services partners
• reputed company employees working remotely will be required to adhere to reputed company's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $132,200 to $226,600 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job